Some doctors question CDC’s guidance on Ebola patients

Hospitals nationwide are hustling to prepare for the first traveler from West Africa who arrives in the emergency room with symptoms of infection with the Ebola virus.

Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), has said such a case is inevitable in the United States, and the agency this month issued the first extensive guidelines for hospitals on how to recognize and treat Ebola patients.

The recommendations touch on everything from the safe handling of lab specimens to effective isolation of suspected Ebola patients. One piece of advice in particular has roused opposition from hospital administrators.

The CDC says that health-care workers treating Ebola patients need only wear gloves, a fluid-resistant gown, eye protection and a face mask to prevent becoming infected with the virus. That is a far cry from the head-to-toe “moon suits” doctors, nurses and aides have been seeing on TV reports about the outbreak.

Some hospital officials are skeptical of the new advice. “It’s not going to be enough for my health-care workers to feel comfortable going into an isolation room,” said Peggy Thompson, director of infection prevention at Tampa General Hospital.

If a suspected Ebola patient arrives at her hospital, Thompson intends to outfit staff members in fluid-resistant jumpsuits with bootees, taped seams and hoods. They cost about $175 per dozen. She has not decided how many to order.

Faced with “copious amounts” of vomit or diarrhea, the CDC acknowledges that leg coverings or double gloving might also be needed.

But, “We don’t always know when a patient is going to vomit,” Thompson, a former nurse, pointed out.

The Ebola virus is spread through contact with body fluids, such as those in blood, sweat, saliva or feces. While it is not an airborne virus like the flu, contaminated droplets can be released briefly into the air during procedures performed on infected patients, such as the insertion of a breathing tube. In that case, the CDC recommends the use of air-purifying respirators.

In recent weeks, CDC officials have said repeatedly that any hospital in the United States can safely provide care for a patient with Ebola by following exacting, infection-control procedures and isolating the patient in a private room with an unshared bathroom.

“What’s needed to fight Ebola is not fancy equipment,” Frieden said in a message posted during a Twitter chat with members of the hospital staff. “What’s needed is standard infection control, rigorously applied.”

Nancy Foster, vice president of quality and patient-safety policy at the American Hospital Association, agreed that gloves, gown, face mask and eye protection are “perfectly fine” and called the CDC guidance the “best advice.”

But Dr. Michael Callahan, an infectious-disease specialist at Massachusetts General Hospital who has worked in Africa during Ebola outbreaks, does not think it is wrong for hospitals to opt for more protective equipment.

Dr. Justin Fairless, an emergency physician in Tulsa, Okla., said health-care workers in Africa “are wearing the highest level of protection, but the CDC recommendation lets us go down to the lowest level of protection.”

Fairless may buy his own air-purifying respirator to pair with a head-to-toe coverall. “I am not comfortable going to see an Ebola patient wearing a paper mask that doesn’t cover my entire face,” he said.

In recent weeks, several hospital workers have expressed concerns, asking why head coverage is not necessary and suggesting emergency-department doctors should get hard-to-tear hooded suits.

Dr. David Kuhar, health-care and worker-safety team leader for CDC’s Ebola response, said that caring for patients in Africa is “very different” from caring for those in a hospital in the United States.

Until recently, those tending to Dr. Kent Brantly and Nancy Writebol, the Americans infected with Ebola in Liberia, wore head-to-toe suits at Emory University Hospital in Atlanta. On Wednesday, Dr. Phyllis Kozarsky said the nurses had shed their full-body gear and were following “what CDC guidance says for the management of these patients.”